Course of Depressive Symptoms After Myocardial Infarction and Cardiac Prognosis: A Latent Class Analysis

Department of Psychiatry, University of Groningen, Groningen, Groningen, Netherlands
Psychosomatic Medicine (Impact Factor: 3.47). 09/2006; 68(5):662-8. DOI: 10.1097/01.psy.0000233237.79085.57
Source: PubMed


The presence of depressive symptoms after myocardial infarction (MI) is a risk factor for new cardiovascular events. The importance of the course of post-MI depressive symptoms for cardiac prognosis is not clear. We therefore set out to investigate whether different courses of post-MI depressive symptoms can be identified and determine their associations with cardiac events.
Data were derived from the Depression after Myocardial Infarction (DepreMI) study, a naturalistic follow-up study of patients admitted for an MI in four hospitals in The Netherlands (N = 475). Scores on the Beck Depression Inventory (BDI) during hospitalization and at 3, 6, and 12 months post-MI were analyzed. Using latent class analysis (LCA), we identified classes characterized by distinctive courses of depressive symptoms and then examined their link to cardiac prognosis.
The prevalence of significant depressive symptoms ranged from 22.7% to 25.5% throughout the post-MI year. Five distinct courses were found: no depressive symptoms (56.4%), mild depressive symptoms (25.7%), moderate and increasing depressive symptoms (9.3%), significant but decreasing depressive symptoms (4.6%), and significant and increasing depressive symptoms (4.0%). Subjects in this last class had, statistically, a significantly higher risk for a new cardiovascular event compared with subjects without depressive symptoms (hazard ratio (HR) = 2.73; p = .01). Controlling for baseline cardiac status and sociodemographic data did not alter the association (HR = 2.46; p = .03).
Post-MI depressed subjects with significant and increasing depressive symptoms are at particular risk of new cardiac events. This subgroup may be most suited for evaluation of the effects of antidepressant treatment on cardiac prognosis.

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Available from: Peter De Jonge, Jun 17, 2015
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    • "Why was living alone a risk factor among AMI survivors after discharge? Previous studies showed that depression symptoms were a significant predictor of subsequent cardiovascular events after AMI onset [12] [16] [17]. Therefore, depression symptoms by psychological stress after discharge in AMI survivors who were living alone might lead to the increased number of subsequent cardiovascular events [10]. "
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    ABSTRACT: Background: Little is known about the long-term risk of cardiovascular events after discharge among acute myocardial infarction (AMI) survivors living alone in Japan. Methods and results: A large-scale prospective, observational study in the Osaka region involved consecutive patients with AMI from January 2002 through December 2010. We evaluated the association between living alone and longitudinal risk of cardiovascular events following discharge after AMI. A Cox proportional-hazards model was used to assess the association between living alone and the primary composite endpoint consisting of major adverse cardiovascular events and total deaths. During the study period, 5845 patients (4415 male patients, 1430 female patients) were registered. Living alone was found to be independently associated with a higher risk of composite endpoint consisting of major adverse cardiovascular events and total deaths [adjusted hazard ratio (HR) 1.32; 95% confidence interval (CI): 1.11-1.58]. Multivariate-adjusted HRs of composite endpoint were 1.34 (95% CI: 1.08-1.68) among male patients and 1.31 (95% CI: 0.95-1.81) in the female patients. AMI survivors living alone tend to have a higher adjusted HR of composite endpoint than those not living alone irrespective of age and gender groups. Conclusions: From this large AMI registry in Osaka, AMI survivors living alone after discharge had a higher risk of cardiovascular events and total deaths than those not living alone.
    Journal of Cardiology 06/2013; 62(3-4). DOI:10.1016/j.jjcc.2013.04.009 · 2.78 Impact Factor
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    • "Baseline assessment was undertaken 3 months post-discharge, rather than during admission, as well as to avoid potential confounding of the effects of acute illness and stress associated with hospitalization with the assessment of predictor variables and to minimize the burden on participants. Other studies [22,23,32] have highlighted difficulties in reliably identifying patients in whom depression will emerge, persist or worsen only on the basis of level of depressive symptomatology present during hospitalization. Structured clinical interviews were administered telephonically at T1. Telephonic administration of structured clinical interviews has been found to be valid and reliable [33,34]. "
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    ABSTRACT: Background We report on the prospective association between smoking and depression and health-related quality of life (HRQOL) in patients with coronary artery disease (CAD). Methods Prospective study of 193 patients with assessment of depression occurring 3-, 6- and 9- months (T1, 2, and 3, respectively) following discharge from hospital for a cardiac event. HRQOL was assessed at T3. T1 depression was assessed by clinical interview; T2 and T3 depression was assessed by self-report. Smoking at time of cardiac event was assessed by self-report. Multivariate analyses controlled for known demographic, psychosocial and clinical correlates of depression. Results Smoking at the time of index cardiac event increased the likelihood of being diagnosed with Major Depressive Disorder (MDD) at T1 by 4.30 [95% CI, 1.12-16.46; p < .05]. The likelihood of receiving a diagnosis of minor depression, dysthymia or MDD as a combined group was increased by 8.03 [95% CI, 2.35-27.46; p < .01]. Smoking did not reliably predict depression at T2 or T3 and did not reliably predict persistent depression. Smoking increased the likelihood of being classified as depressed according to study criteria at least once during the study period by 5.19 [95% CI, 1.51-17.82; p < .01]. Smoking independently predicted worse mental HRQOL. Conclusions The findings support a role for smoking as an independent predictor of depression in CAD patients, particularly in the first 3 months post-cardiac event. The well-established imperative to encourage smoking cessation in these patients is augmented and the findings may add to the evidence for smoking cessation campaigns in the primary prevention of depression.
    BMC Cardiovascular Disorders 05/2013; 13(1):35. DOI:10.1186/1471-2261-13-35 · 1.88 Impact Factor
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    • "Furthermore, rather than being a transient reaction to a cardiac event, depression for many patients exists for months or years before and persists long after the event [15–22]. In studies that examine the course of post-MI depression, depressive symptoms remain at steady levels of severity over the 12 months after an MI [19, 20]. Similar results have been observed in patients with chronic CVD, such as those with ICDs; in this cohort, 80% of patients who are depressed at the time of ICD placement continue to suffer from depressive symptoms 2 years later [22]. "
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    ABSTRACT: In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities-may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
    Cardiovascular Psychiatry and Neurology 04/2013; 2013:695925. DOI:10.1155/2013/695925
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